| Organization Name: | PENUELAS DENTAL TEAM LLC |
| NPI Number: | 1679976914 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IVAN TORRES (PRESIDENT) |
| Mailing Address: | 628 Pedro Velazquez Edificio Aurora 3b Penuelas |
| State: | PR US |
| Postal Code: | 00624 |
| Phone Number: | 7878363333 |
| Fax Number: | 7878361729 |
| NPI Enumeration Date: | 10/01/2014 |
| NPI Last Update Date: | 10/01/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 2851 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |